Gupta Kavita, Savin Ziv, Lundon Dara, Connors Christopher, Serna Juan, Ricapito Anna, Khargi Raymond, Shimonov Roman, Yaghoubian Alan J, Gallante Blair, Atallah William M, Gupta Mantu
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Icahn School of Medicine at Mount Sinai, 424 W. 59th Street, Suite 4F, New York, NY, 10019, USA.
World J Urol. 2025 Sep 1;43(1):523. doi: 10.1007/s00345-025-05901-0.
Percutaneous nephrolithotomy (PCNL) has undergone numerous technological innovations recently that make it even less invasive, but global adoption of these innovations remains unclear. This study sought to compare the effect of region and education on the penetrance of recent advances in PCNL worldwide.
An anonymous 32-item survey was developed and distributed via the Endourological Society's Twitter/X account in November 2023. The survey collected data on participants' geographic region, PCNL volume, fellowship training, and PCNL practices. Descriptive statistics were calculated, and chi-square or Fisher's exact tests were used for comparisons.
Responses were received from 160 PCNL providers worldwide. Respondents were categorized by geography, fellowship training, and procedural volume. Spinal anesthesia was more commonly used by Asian providers (31%, p = 0.001), while supine positioning was notably more common in Europe (76%, p = 0.001). Asian providers favored pneumatic energy (63%), while North American and European providers more frequently used dual energy lithotripters (31-72%) and hemostatic tract agents (p < 0.001). High-volume providers and those with more post-fellowship experience tended to use smaller sheaths, including mini-PCNL. Postoperative imaging practices also varied by region and fellowship-training status.
PCNL practices vary significantly worldwide, influenced by regional, economic, and experiential factors. Our survey indicates a significant shift in practices with 41% of providers using supine position and over 50% doing tubeless PCNL. However, ultrasound access has been slow to gain widespread use with 73% still using predominantly fluoroscopy, similar to prior studies. Further randomized studies are needed to establish the clinical effectiveness of new technologies and to drive standardization of care across geographic and economic barriers.
经皮肾镜取石术（PCNL）近年来经历了众多技术创新，使其侵入性更小，但这些创新在全球的应用情况仍不明确。本研究旨在比较地区和教育水平对PCNL近期进展在全球范围内普及程度的影响。
2023年11月，通过腔内泌尿外科协会的推特/X账号开展了一项包含32个项目的匿名调查。该调查收集了参与者的地理区域、PCNL手术量、专科培训情况以及PCNL操作实践等数据。计算描述性统计数据，并使用卡方检验或费舍尔精确检验进行比较。
全球160名PCNL提供者回复了调查。受访者按地理区域、专科培训情况和手术量进行分类。亚洲提供者更常使用脊髓麻醉（31%，p = 0.001），而仰卧位在欧洲更为常见（76%，p = 0.001）。亚洲提供者更倾向于使用气动能量（63%），而北美和欧洲提供者更频繁地使用双能量碎石机（31 - 72%）和止血通道剂（p < 0.001）。手术量大的提供者以及专科培训后经验更丰富的提供者倾向于使用更小的鞘管，包括迷你PCNL。术后成像实践也因地区和专科培训状况而异。
全球范围内PCNL操作存在显著差异，受地区性、经济性和经验性因素影响。我们的调查表明操作有显著转变，41%的提供者使用仰卧位，超过50%的人进行无管PCNL。然而，超声引导的应用推广缓慢，73%的人仍主要使用荧光镜检查，这与先前的研究类似。需要进一步的随机研究来确定新技术的临床有效性，并推动跨越地理和经济障碍的护理标准化。
